Grommet Consent Form

Grommet Gurus Consent Form
Name of Participant

First NameLast Name
Name of Parent/Guardian

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have family members involved in the program?
Who are the family members involved
This will help identifying right patrol group.
What are your interests?
What do you want to get out of lifesaving and this program?
If yes, What Patrol Group are they?

1234N/A
Do you give permission for photos to be taken of your child and posted in Grommet Gurus Private Facebook Group for Parents and Participants?

YesNo
Do you give permission for photos to be taken of your child and posted on the Grommet Gurus Public Facebook and Instagram pages?

YesNo
I Parent/Guardian the parent/guardian of Participant's Name give consent for my child to partake in the Grommet Gurus Program.
Signature of Parent/Guardian
Date

MonthDayYear
Date
Should be Empty:

Grommet Gurus Consent Form